老年急性心肌梗死患者急诊冠状动脉支架术的临床评价

目的　探讨老年急性心肌梗死 (AMI)患者急诊冠状动脉支架术的临床疗效和安全性。方法　共对 95例住院老年AMI患者的 10 4支靶血管、114处靶病变急诊植入冠状动脉支架 110枚。患者术前合并心源性休克 2 9例 ,心肺复苏 3例 ,急诊冠状动脉造影示多支病变 5 8例 ,梗死相关动脉 (IRA)狭窄 99%～ 10 0 % ,心肌梗死溶栓试验 (TIMI)血流 0级 72例 ,1～ 2级 2 3例。结果　IRA开通率 10 0 % ,110枚支架均植入成功 ,术后平均残余狭窄 (0 .4± 3.5 1) % ,全部恢复TIMI 3级血流 ,无操作并发症 ,即刻成功率 10 0 %。从入导管室至IRA开通时间平均 (17.6± 1.87)min。术后共 6例死亡 ,住院期间总病死率 6 .3% ,其中 4例死于不可逆心源性休克 (休克病死率 13.8% )。对出院的 89例随访 1～ 5 2个月 ,平均 (2 5 .1± 12 .3)个月 ,87例存活 ,存活率 97.8%。 2 8例造影随访者中 5例支架内再狭窄 (再狭窄率17.8% )。结论　急诊支架术对老年AMI患者具有理想的即刻和长期疗效。合理选择器械、操作技术熟练和围术期并发症处理经验是保证老年AMI急诊冠状动脉支架术获得高成功率的 3个关键。

Clinical evaluation of emergency coronary stenting in the elderly patients with acute myocardial infarction

Objective To evaluate the clinical therapeutic efficacy and safety of emergency coronary stenting in elderly patients with acute myocardial infarction (AMI).Methods Ninety five elderly AMI patients were admitted to our hospital.Of them,29 patients were complicated with cardiogenic shock and 3 succeeded in cardio pulmonary resuscitation.Emergency angiography showed that 58 patients had multivessel coronary artery disease and all had severe narrowing of 99% to 100% in infarct related arteries (IRA),72 patients were in TIMI 0 flow and 23 in 1～2 flow before operation.110 stents were implanted in 104 target vessels with 110 target lesions in 95 patients.Results All IRAs were opened and 110 stents were successfully implanted.The residual stenosis was (0.4±3.51)% and TIMI 3 flow was reached in all patients after operation.There were no complications during the procedure and the rate of primary operation success was 100%.The door to balloon time was 17.6±1.87 minutes.Six patients died after operation and inpatient mortality was 6.3%.Of them,4 patients died of irreversible cardiogenic shock (shock mortality 13.8%).Eighty nine discharged patients were followed up for 25.1±12.3 months (from 1 to 52 months) and the survival rate was 97.8%.Twenty eight patients underwent angiographic follow up and instent restenosis was found in 5 cases (restenosis rate 17.8%). Conclusions The emergency coronary stenting has immediate and long term satisfatory therapeutic efficacy for the elderly patients with AMI.The following three factors are the key for ideal efficacy:proper devices chosen,skillful manipulation and experience for managing peri operation complications.